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Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies

Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies

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Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies

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  1. Fear of Falling Among Seniors:Needs Assessment and Intervention Strategies Susan L. Murphy ScD, OTR World Federation of Occupational Therapy Conference June 2002, Stockholm Sweden (part 2 of talk with co-presenter Elizabeth Walker-Peterson MPH OTR/L)

  2. Objectives • Describe fear of falling in terms of its prevalence, contributing factors, and consequences • Discuss research-based strategies to screen clients • Describe and compare several fear of falling assessments

  3. Falls and Fear of Falling • 1 in 3 persons 65 and older experience at least one fall each year • Falls are responsible for 40% of nursing home admissions • Falls can result in soft tissue injuries, fractures, and conditions resulting from long lies on the floor or ground

  4. Fear of Falling • Definition: A lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing (Tinetti and Powell, 1993). • Described as a problem seen in the clinic and in the community

  5. Prevalence of Fear of Falling • 30 - 55% of community-living seniors • 46% of nursing home residents • 50% of seniors with rheumatoid arthritis • 47% of seniors with chronic dizziness • More women report fear of falling than men • may be an underreporting by men • with advanced age, women are at greater risk for falls and fall injuries

  6. Who Develops Fear of Falling and Why? • Longitudinal study of community-living older women (Murphy, Dubin, & Gill) • Factors which predisposed women to reporting fear of falling at follow-up • age over 80 • visual impairment • sedentary lifestyle • lack of available emotional support

  7. Who Develops Fear of Fallingand Why? • Joint contribution of predisposing factors and fall events after baseline: • Predisposing factors were more strongly related to developing fear of falling than fall events • Appears necessary to prevent and treat fear of falling in older women regardless of whether they have a history of falls

  8. Possible Consequences of Fear of Falling • Increased caution during activity performance • Excessive restriction of activities • Diminished quality of life

  9. The Impact of Fear of Falling on Activity Performance Fear of falling Restricts activity Physical capabilities reduced Restricts more activities More impaired physical capabilities

  10. The Impact of Fear of Falling on Quality of Life • Reduced social interaction • Preoccupied thoughts • Extreme anxiety Diminished Quality of Life Fear of Falling Activity Restriction

  11. Results of Longitudinal Studies Fear of Falling at baseline associated with several negative outcomes at follow-up: • Increased risk for falls • declines in ability to perform ADLs • declines in gait • lower health-related quality of life • increased risk of nursing home admission (Cumming et al., 2001, Vellas et al., 1997)

  12. Screening Seniors for Fear of Falling

  13. Fear of Falling • A lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing • For screening purposes, it is necessary for the therapist to assess a senior’s: • Personal abilities • Activity performance • Assess in conjunction with screening instruments

  14. Activity Performance • Current activities performed • environmental constraints • Fearfulness while performing activities • Which activities are being restricted • activities necessary for independent living • activities that are meaningful for individual

  15. When Is Fear of Falling a Problem? Personal Abilities Activity Performance • Person is performing activities that are appropriate for level of abilities

  16. When Is Fear of Falling a Problem? Personal Abilities Activity Performance • Person has excessive fear or is restricting activities that he/she should otherwise be able to perform

  17. Direct Assessments Indirect Assessments Screening Instruments

  18. Purpose Items included (#, Type) Population tested (If applicable) Validity Reliability Pros Cons Fear of Falling Instruments

  19. Validity and Reliability Validity Reliability (Does the instrument test (Does the instrument measure what it is supposed to test?) consistently over time?) Criterion Internal Consistency Construct Test-Retest Content

  20. Howland-Peterson Index How concerned are you that you will fall and hurt yourself in the next year? 1 = Very concerned 4 = Not at all concerned + useful to measure prevalence -- difficult to detect change

  21. Client’s status Functional level Health issues Response to instrument’s wording Negative vs. Positive Characteristic the instrument measures Fear Restriction Confidence Purpose of using a screening instrument Comparison Pre and post test Choosing an Instrument